Re: Evaluating Abuse Cases

["Murray A. Straus" <mas2@xxxxxxxxxxxxxxx>]

Dear Colleagues:

I thought you might be interested in my response to a member of this list
who replied to my posting pointing to the evidence that spanking is a risk
factor or physical abuse.  He said:

Of course the above is true.  But it is also true that most alcohol abuse
>is in the form of social drinking that has escalated out of control, and
>that most alcoholics started by drinking milk. My concern continues to be
>on the effects of our efforts in reaching our audience, and if we make the
>average family feel attacked and defensive, we will not be heard.

HERE IS HOW I REPLIED:

If escalation into abuse was the only problem with spanking,  I would be
more inclined to agree with you.   But there are important  differences
between
drinking and spanking that make it desirable to prohibit one and not the
other.

One difference is that "moderate drinking" is not harmful to the
drinker, but "moderate spanking"  is harmful to children.   I will send you
a copy of my response to Chuck Smith at Kansas State on whether "moderate
spanking, done rarely, is harmful.  (My response is at the end of this
posting).

But perhaps the most fundamental difference is that spanking is the
euphemism that we use for physical assaults on children as a means of
discipline.   I find that morally unacceptable mode of human relationship,
even if it works.

Of course, if nothing else works (as many people believe),  then I would
have to accept spanking.   But the empirical evidence,  even in the studies
by defenders of corporal punishment such as Bob Larzelere,  shows that other
methods work as well or better.   Consequently, there is no need to accept a
morally dubious practice because alternatives are available that work as
well in the short run and work MUCH better in the long run.

Almost everyone in parent education I talk to shares your concern about "the
effects of our efforts in reaching our audience, and if we make the average
family feel attacked and defensive, we will not be heard."    In response, I
would like to point out that there is no empirical evidence that this any
more for advice to "not spank"  than would happen with advice to "not let
the child stay up at night as long as she wants"  or "not serve a diet
consisting mostly of meat and ice cream"

There was an interesting discussion in the familysci list a few weeks ago in
methods of dealing with controversial issues such as spanking in ways that
do not make parents feel attacked.    At leas one of those messages included
a detailed paradigm for doing this.   I do not do parent education,  so I
did not save it.   I wish I had so that I could have forwarded it to you.
But perhaps famsci keeps an archive and you can get it.

NOW HERE IS MY REPLY TO SMITH:

Dear Prof. Smith:

This letter is a commentary on your statement that there is little research
on whether "infrequent, mild physical punishment has clear long-term
negative consequences for children"

I agree that there is little research on this issue, and I would add that
what evidence there is, is not definitive.

WHY THE LACK OF STUDIES OF THIS ALMOST UNIVERSAL ASPECT OF CHILD REARING IN
AMERICA?  One of the reasons for the lack of research is that almost all
psychologist, like almost all of our fellow citizens, have regarded it as so
obvious that there are no negative consequences that they have not
investigated it.  Investigating an issue like that requires a major
commitment of ones most valuable resource -- time.  So, it takes someone who
regards the idea that CP is harmful, even when infrequent and by loving
parents, as a reasonable hypothesis, to feel that it is worth investing
their limited time and other resources.

SOME RESEARCH ON THE EFFECTS OF INFREQUENT CP BY LOVING PARENTS.  Here is
what I found in three studies:

1. On page 108, of my book Beating the Devil Out of Them: Corporal
Punishment in American Families, you will find a graph showing that just one
instance of corporal punishment (CP) in the past year is associated with a
higher probability of delinquency. This analysis controlled for a number of
other variables, including whether the parents were violent to each other,
socioeconomic status, age and sex of the parent and the child, etc.

2. Figure 1 of my article with Vera Mouradian  on "Impulsive corporal
punishment by mothers and antisocial behavior and impulsiveness of children"
(Behavioral Sciences and the Law. 16, 353-374 (1998) reports on a study in
which we classified the children into the following CP categories: Never,
Not in the last six months, but before that, once in the past six months,
twice, 3-5 times, and six or more times. The analysis controlled for a
number of other variables, including the age of the child, socioeconomic
status, and the level of parental nurturance. We found that for children of
all ages, and for children who experienced a high level of parental
nurturance as well as those who did not, antisocial behavior by the child
was lowest for those who never experienced CP. Then it went up for those who
experienced it earlier, but not in the past six months, and then went up
more for those who experienced it more often. Figure 3 shows that this
applies even to those children whose mother's followed the recommendation to
not use CP impulsively.

3.  In a paper now under review, we report on a study of a nationally
representative sample of 804 2 to 4 year old children.  CP was measured in
two sample weeks a year apart.  Only 53 had not  experienced CP in either of
two sample weeks.  This small group however is crucial for the question of
whether infrequent CP is harmful.   They showed the greatest gain in
cognitive ability from the initial testing to the resetting 2 years later.
Children who experienced even one instance of CP in those two sample weeks
gained less, and those who experienced more than one instance actually fell
behind the average increase in cognitive ability that occurs as children
mature.  We concluded that even one instance of CP inhibits cognitive
development by a small (but statistically reliable) amount.

WHAT SHOULD WE TELL PARENTS?   More research is needed, but in the meantime,
for the reasons to be given in the paragraphs which follow, I believe there
is a scientific and ethical obligation to inform parents that the currently
available research indicates that even infrequent CP by loving parents
increases the probability of harmful effects.  At the same time, we should
also reassure parents that, if they have used CP, the chances are that the
child will NOT show harmful side effects.

THE CONCEPT OF "RISK FACTOR"   The reason most children will not show
harmful side effects is because the relation of exposure to a pathogen to
occurrence of a harmful outcome is rarely in the form of a one-to-one causal
relation.  Rather,  it takes the form of a "risk factor."   That is,
exposure to a pathogen,  whether it be smoking or spanking, increases the
probability of the harmful effect and does not guarantee it.  For example,
the risk of death from a smoking related disease is about 1 out of 3 for
those who smoke a pack a day or more. This same figure means that 2 out of
three heavy smokers will be able to say "I smoked all my life, and I'm ok."
This is true, but the implication that smoking is ok is not. Similarly, most
people who were spanked can say "My parents spanked me and I'm ok" Again,
that is true, but the implication that spanking is ok, in the sense of no
harmful side effects, is not.

A main difficulty with this analogy is that the risk ratio is much lower for
CP than for smoking. For heavy smoking it is about 1 out of 3, whereas for
heavy spanking the risk is usually closer to 10% (depending on the outcome
variable). Or putting it another way, the effect size for CP is small, and
even smaller when spanking is done only infrequently. But it is still there
and statistically reliable.

IF THE EFFECT SIZE IS SO SMALL, IS IT WORTH WORRYING ABOUT?   For parent
educators,  a key question is whether it is  worth pushing "no-spanking" in
the face of the fact that almost all parents believe it is "sometimes
necessary"?  Here are two of the reasons I think it is:

1.  Spanking is unnecessary because other methods of discipline are equally
or more effective. Even Bob Larzelere's research shows this. He found that
explaining, or just moving the child, etc. had the same "time to failure"
i.e. repetition of the crime, as did spanking. However, almost everyone
thinks that spanking works when other things do not. In fact, with toddlers,
all methods of discipline need to be repeated over and over again.  Parents
are prepared to spank over and over again, and they do. In one study, for
example, I asked the mothers to identify the last thing they had spanked
for, and then I asked if they had spanked for that previously.  Seventy four
percent had spanked for the same thing previously.  But when the child
repeats the misbehavior following other modes of discipline, parents usually
conclude that the method does not work and they have to turn to spanking.
They just do not perceive that spanking has also not worked in the past.
One can get parents to use simple behavioral tracking and this will allow
almost any parent to demonstrate this to themselves.

2. If the above can equally accurately be stated as "spanking works just as
well as other methods,"  why not spank?  The answer is first that  the side
effects of non-corporal discipline are generally things we want to see in a
child, whereas the side effects of spanking are generally things we don't
want to see in the behavior of a child. If we use explaining and reasoning,
the parental example teaches the child to expect and use explanations and
reasoning. That can be a big pain sometimes, but it will serve the child
well in the long run.  On the other hand, if we slap and spank to correct
misbehavior, the parental example teaches the child to slap and hit when
other children persist in misbehavior.  Second, although in the immediate
situation, spanking works just as well, the long term effect is an increase
in the probability of behavior problems and an increase in the probability
that the child will be difficult to manage.  (Remember that, as with
smoking, we are dealing increased probabilities, not one-to-one
relationships.)

ADVICE WHEN EVIDENCE IS INCONCLUSIVE.  Finally, I want to return to the fact
that the presently available evidence is not conclusive.  Is it
scientifically responsible to give advice to parents based on less than
conclusive evidence? There are circumstances when parents ARE benefited by
advice based on research that is less than conclusive. One example is
research which suggests, even though not conclusively, that a certain drug
might have serious side effects.  Advice based on that non-definitive
evidence would be appropriate if there are equally effective drugs available
that do not have those side effects.  Similarly, the abundance of evidence
indicating that CP may have harmful side effects, even though it is
inconclusive,  is sufficient to require advising parents to not spank
because, as even defenders of spanking such as Larzelere, point out, there
are ?Many other discipline responses have proven to be effective."  Thus
when parents avoid CP they are reducing the risk of harmful side effects
without giving up a necessary mode of discipline.

Sincerely,

Murray A. Straus, Professor of Sociology
& Co-Director,  Family Research Laboratory
University of New Hampshire,  Durham, NH 03824
Phone:  603 862-2594   Fax:  603 862-1122
E-mail  MAS2@CHRISTA.UNH.EDU

See the Family Research Laboratory web site http://www.unh.edu/frl
for bibliography of books and papers by members of the lab,  conference
announcements,  and information about the lab faculty and research program.
-----Original Message-----
From: Murray A. Straus <mas2@christa.unh.edu>
To: CHILD-MALTREATMENT-RESEARCH-L@cornell.edu
<CHILD-MALTREATMENT-RESEARCH-L@cornell.edu>
Date: Monday, February 22, 1999 1:42 PM
Subject: Re: Evaluating Abuse Cases


>Dear Colleagues:
>
>I did not comment on Mark Chaffin's posting because he indicated it was a
>study of identified abuse cases, and like Tom Chibucos,  my main interest
is
>in primary prevention.   But now that Tom has focused our attention on
>primary prevention,  I will bring up a "risk factor"  that has been
>documented over and over again, but is ignored:  spanking and other legal
>forms of corporal punishment (CP),  such as slapping a child's hand.    As
>long ago as 1970, David Gil wrote that ending use of CP is "likely to
>produce over time the strongest possible reduction of the incidence and
>prevalence of physical abuse of children."
>
>The empirical evidence showing a link between CP and physical abuse is
>reviewed in my book  Beating the Devil Out of Them: Corporal Punishment in
>American Families.   One of the best of these studies is  the book by
>Kadushin ad Martin (1981) which found that most physical abuse is in the
>form of  CP that has escalated out of control, and provides in-depth case
>examples.
>
>The chapter in my book on the relation of CP to physical abuse, in addition
>to reviewing the literature,  tries to explain why CP has been ignored in
>studies and interventions intended as primary prevention of physical abuse.
>It then presents and tests a theoretical model using data on a nationally
>representative sample of over 3,000 families.   The results, even after
>controlling for eleven potential confounds (e.g. family socioeconomic
>status,  whether there was violence between the parents), strongly support
>the idea that elimination of CP would be an important step toward primary
>prevention of physical abuse.    I will be glad to send you a free copy of
>the book if you Email me with your postal address.
>
>    Murray
>
>Murray A. Straus, Professor of Sociology
>& Co-Director,  Family Research Laboratory
>University of New Hampshire,  Durham, NH 03824
>Phone:  603 862-2594   Fax:  603 862-1122
>E-mail  MAS2@CHRISTA.UNH.EDU
>
>See the Family Research Laboratory web site http://www.unh.edu/frl
>for bibliography of books and papers by members of the lab,  conference
>announcements,  and information about the lab faculty and research program.
>-----Original Message-----
>From: Thomas R. Chibucos <tchibuc@bgnet.bgsu.edu>
>To: Child Maltreatment Researchers
><CHILD-MALTREATMENT-RESEARCH-L@cornell.edu>
>Date: Monday, February 22, 1999 7:13 AM
>Subject: Re: Evaluating Abuse Cases
>
>
>>Fellow Netters
>>
>>Mark Chaffin's comment below is as accurate a statement as can be made on
>>the subject.
>>
>>I would add and extend Chaffin's comments in the following way.  In my
>>view, the statement also provides a very strong case for a focus on
primary
>>prevention analogous to the approach that has worked extremely well in the
>>medical field.  We don't try to figure out who is "at risk" for TB, for
>>example.  Everyone gets innoculated.  To be sure, there is not a single
>>innoculant to prevent physical child abuse, or, indeed, any of the other
>>kinds of child abuse.
>>
>>However, we do know some  important demographic, historical and behavioral
>>variables, attention to which would dramatically reduce risk.  Here are a
>>few: substance use; social isolation; lack of preparation for parenthood;
>>absence of sustained support for parenting; parent's own mistreatment when
>>coupled with not having had a meaningful developmental support experience
>>to deal with that mistreatment; mental illness; sustained economic
>>deprivation; sexism; racism.
>>
>>Our collective focus should be on moving the entire  "continuum of
>>treatment of children" from the less favorable to the more favorable
>>direction--moving the mean of favorable treatment and all deviations from
>>the mean in a positive direction.  Yes, there will always be kids at the
>>low end, and yes, this entire approach requires sustained attention at all
>>levels of society.  But, the alternative seems to me to be the continued
>>search for scapegoats, and for putative easy fixes.  Mistreatment is
>>complex and difficult to predict and to understand, and it is
>>multidimensional in nature--just as "good" treatment of children is.  Why
>>should the fix be easy?  Rather than continued feeble attempts to predict
>>risk (and, again, the data are absolutely clear as to how useless this
>>process is), why not tackle the problem from an
>>"individual/family/community/society assets" perspective?  To wit: what
>>variables predict healthy(ful) behavior in children and healthy(ful)
>>treatment of children (by parents, teachers, "the community," society)?
>>Social science research actually does know a lot about this.
>>
>>The research-clinical-policy nexus is clear, and neither researchers nor
>>clinicians are intelligently informing policy on these matters.  But, this
>>is not new.  Some 30 years ago when I was a graduate student, the data
were
>>clear that clinical prediction was worse than useless.  This is still the
>>case: the data are stronger than ever, yet people keep using the
oxymoronic
>>clinical prediction!   For reasons that (what?..are
>>delusional?...self-serving?...make people feel useful?) the irrelevance
>>continues.  It is like looking for child abusers among strangers to
>>children when the empirical evidence is overwhelming that it is close
>>relatives and significant others who account for all but a tiny proportion
>>of direct child abuse.  Ethics, indeed!   How ethical is it for
researchers
>>and clinicians to pretend that they can do something they cannot do.  It's
>>like obtaining a significant r = .20 between two variables, then writing a
>>discussion section as if this means something useful.  The saving grace of
>>the latter is that hardly anyone reads the stuff--unlike the pap that
leaks
>>out because it addresses a significant social problem.
>>
>>We have a collective responsibility to effect an immediate paradigm shift
>>in this area, the hallmark of which should be to transfer to the
>>prevention, treatment, and policy realms research information that is,
>>indeed, reliable and valid.  When we don't have such data-based
>>recommendations to make about applied matters, we should at least shut up
>>about it, or at best, actively discourage unsupported use of approaches,
>>instruments, etc.
>>
>>Sincerely,  Tom Chibucos
>>
>>
>>At 10:18 AM 2/9/99 -0600, you wrote:
>>> We are currently conducting an NCCAN-funded controlled treatment
>>>outcome study for physically abusive parents and have struggled with the
>>>question of assessment.  In addition to looking for measures related to
>>>treatment outcome (Eyberg's DPICS-II observational coding system,
Conflict
>>>Tactics Scale P/C, Child Abuse Potential Inventory, etc.), we were
>>>interested in instruments measuring empirically documented risk-relevant
>>>constructs (e.g. depression, antisocial personality, substance abuse) and
>>>consequently are using the BDI and substance abuse and ASP modules from
>the
>>>Diagnostic Interview Schedule (DIS) in addition to  the usual
>risk-relevant
>>>historical and demographic factors (age, number of children, number of
>>>previous reports/incidents, etc.).
>>> However, I must say that this entire discussion is a bit
>>>disconcerting because, as far as I'm aware, psychological testing has
been
>a
>>>poor performer in predicting anything of forensic relevance in child
abuse
>>>cases.  My reading of the risk literature is that demographic, historical
>>>and behavioral factors are the most robust predictors of risk--not tests.
>>>Possibly the only thing less accurate than tests is clinical judgement.
>I'm
>>>sure we're all aware of the literature documenting the poor track record
>>>clinical impressions have in predicting any kind of future violent
>behavior.
>>>The CAPI has good predictive validity for screening purposes, but is not
>>>usually recommended for assessing a forensic case.  Perhaps what we
should
>>>be doing is more of an actuarially based historical-behavioral analysis
>and
>>>not muddying the waters with test information which is mostly error
>>>variance. This is exactly what people are doing in assessment of sexual
>>>abusers (i.e. Quinsey, et al's VRAG, Hanson, et al's RRASOR, etc.), which
>>>makes me wonder why we are wasting so much public money giving physical
>>>abusers MMPI's and Rorschachs to determine......well, to determine what?
>>> If anyone is aware of any empirical evidence that projective tests,
>>>or any other personality test, offer any incremental predictive validity
>in
>>>child abuse cases, I'd love to see it.  In the absence of this, I must
>>>respectfully disagree with the author who suggested that he could give
any
>>>test he pleases.  My reading of our ethical requirements is that
>>>psychologists should only use tests which have clear empirical support
for
>>>the specific purposes and with the specific population where they are
>used.
>>>I think we owe our clients, our courts, and our CPS systems something
>better
>>>than "clincal judgement," regardless of whether or not its haphazardly
>>>butressed with MMPI's and Rorschachs.
>>>
>>>Mark Chaffin, Ph.D.
>>>Center on Child Abuse and Neglect
>>>University of Oklahoma Health Sciences Center
>>>mark-chaffin@ouhsc.edu
>>>
>>******************************************************
>>Views expressed are mine alone, unless otherwise noted.
>>******************************************************
>>Thomas R. Chibucos, Ph.D.
>>Professor, Human Development and Family Studies
>>Chair, School of Family and Consumer Sciences
>>217 Johnston Hall
>>Bowling Green State University
>>Bowling Green, OH  43403-0254    Phone: (419) 372-7823    FAX: (419)
>>372-7854
>